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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603800
Report Date: 05/09/2024
Date Signed: 05/09/2024 02:45:31 PM

Document Has Been Signed on 05/09/2024 02:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:UNYEWAY INCFACILITY NUMBER:
374603800
ADMINISTRATOR/
DIRECTOR:		SWAFFORD, MARGIEFACILITY TYPE:
775
ADDRESS:1689 BROADWAY SUITE 106TELEPHONE:
(619) 691-6346
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 210CENSUS: 116DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Assistant Program Manager Blanca VasquezTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Assistant Program Manager Blanca Vasquez.

Today's visit was in response to an LIC624 Incident Report, which Licensee self-submitted to the CCLD San Diego Regional Office (received on 05/08/2024). According to the LIC624: On 05/07/2024 around 1:55 PM, Client #1 (C1) tripped over the foot of a peer while walking. [See LIC 811 Confidential Names List for a description of C1.] C1 fell forward to the ground, sustaining a chipped tooth and a small laceration on the crown of their head just above the forehead.

During today’s visit, LPA performed a brief facility tour / welfare check on C1, verifying that they were alert, active, and free of pain, and that the laceration on top of their head was closed and healing. LPA also collected copies of and reviewed pertinent care, medical, and hospital records, and interviewed relevant day program staff.

Records and interviews showed: Licensee’s staff immediately responded to C1 after they fell. Simple pressure with gauze and antibiotic ointment was enough to stop the light bleeding from C1’s laceration. At no point did C1 lose consciousness or alertness. Staff timely notified C1’s conservator, who arrived shortly after around 2:10 PM to pick up C1 and transport them to a nearby hospital emergency room (ER) for further evaluation. According to hospital records: CT scans were performed on C1’s head and spine, which showed no fracture or acute injury beyond the above-mentioned laceration, which itself did not require stitches or staples.


[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: UNYEWAY INC
FACILITY NUMBER: 374603800
VISIT DATE: 05/09/2024
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[CONTINUED FROM LIC 809]

The preponderance of evidence showed: Licensee, via coordination with C1’s conservator, ensured that C1 timely received needed medical attention. Licensee also met reporting requirements. No deficiencies were observed or cited during today's visit. However, LPA did provide Technical Assistance (see the LIC9102-TA page) regarding 82075(a) Health-Related Services.

An exit interview was conducted with Vasquez, to whom a copy of this report, the LIC 9102-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC809 (FAS) - (06/04)
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